Stroke, Vol 25, 2403-2406, Copyright © 1994 by American Heart Association
HS Markus, A Clifton, T Buckenham and MM Brown
BACKGROUND AND PURPOSE: Carotid angioplasty may offer an effective
treatment for carotid stenosis, but there has been concern about the
incidence and clinical consequences of distal embolization. Transcranial
Doppler monitoring in carotid endarterectomy has demonstrated embolic
signals during this procedure. We used this technique in patients
undergoing carotid angioplasty. METHODS: Transcranial Doppler ultrasound
was used to monitor for embolic signals in the ipsilateral middle cerebral
artery before and during 10 technically successful carotid angioplasties
and at various standardized times in the following month. RESULTS: In the
month before angioplasty asymptomatic embolic signals were detected in 3 of
10 patients. During angioplasty multiple embolic signals were detected
immediately after balloon inflation in 9 of 10 subjects. A minor
ipsilateral cerebral ischemic event occurred in 1 of these 9, but the other
8 were asymptomatic. Embolic signals were common immediately after the
procedure and intra-arterial femoral catheter removal (8 of 10 subjects)
but thereafter became less frequent and were present in 1 of 5 at 4 hours,
2 of 10 at 48 hours, 1 of 6 at 7 days, and 1 of 10 at 1 month. CONCLUSIONS:
Embolization at the time of carotid angioplasty is very common but usually
asymptomatic; monitoring by means of Doppler ultrasound will allow the
effectiveness of measures to reduce this embolization to be studied. Late
embolization occurs in a minority of patients and may account for the small
but significant risk of delayed stroke. Doppler monitoring may allow
identification of patients at risk and assessment of the effectiveness of
prophylactic therapy.
ARTICLES
Carotid angioplasty. Detection of embolic signals during and after the procedure
Division of Clinical Neuroscience, St George's Hospital Medical School, London, England.
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